1 DAI di Neuroscienze, Azienda Ospedaliera Universitaria Integrata, Verona, Italy.
2 Emergency Department, Girolamo Fracastoro Hospital San Bonifacio, Verona, Italy.
Int J Stroke. 2018 Oct;13(7):700-706. doi: 10.1177/1747493018765490. Epub 2018 Mar 15.
Background and purpose The nomogram is an important component of modern medical decision-making, which calculates the probability of an event entirely based on individual characteristics. We aimed to develop and validate a nomogram for individualized prediction of the probability of unfavorable outcome in intravenous thrombolysis-treated stroke patients included in the large multicenter Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register. Methods All patients registered in the Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register by 179 Italian centers between May 2001 and March 2016 were originally included. The main outcome measure was three-month unfavorable outcome (modified Rankin Scale 3-6). Four non-categorical predictors of unfavorable outcome (baseline National Institutes of Health (NIH) Stroke Scale score: 0-25, age ≥18 years, pre-stroke modified Rankin Scale score: 0-2, and onset-to-treatment time: 0-270 min) were identified a-priori by three neurologists with expertise in the management of stroke. To generate the NIHSS STroke Scale score, Age, pre-stroke mRS score, onset-to-treatment Time (START), the pre-established predictors were entered into a logistic regression model. The discriminative performance of the model was assessed using the area under the receiver operating characteristic curve. Results A total of 15,862 patients with complete data for generating the START was randomly dichotomized into training (2/3, n = 10,574) and test (1/3, n = 5288) sets. The area under the receiver operating characteristic curve of START was 0.800 (95% confidence interval: 0.792-0.809) in the training set and 0.815 (95% confidence interval: 0.804-0.822) in the test set. Conclusions By using a limited number of non-categorical predictors, the START is the first nomogram developed and validated in a large Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register cohort, which reliably calculates the probability of unfavorable outcome in intravenous thrombolysis-treated stroke patients.
列线图是现代医学决策的重要组成部分，它完全根据个体特征计算事件的概率。我们旨在开发和验证一种列线图，用于预测纳入大型多中心溶栓治疗的卒中患者的不良结局的概率。Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register。方法：最初纳入了 2001 年 5 月至 2016 年 3 月期间 179 家意大利中心登记的 Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register 中的所有患者。主要结局指标为三个月时的不良结局（改良 Rankin 量表 3-6 分）。通过三位具有卒中管理专业知识的神经病学家预先确定了四个非分类不良结局预测因子（基线 NIHSS 评分：0-25、年龄≥18 岁、卒中前改良 Rankin 量表评分：0-2、发病至治疗时间：0-270 分钟）。为了生成 NIHSS STroke Scale 评分、年龄、卒中前 mRS 评分、发病至治疗时间（START），将预先确定的预测因子输入逻辑回归模型。使用受试者工作特征曲线下面积评估模型的判别性能。结果：共有 15862 例具有完整 START 生成数据的患者被随机分为训练集（2/3，n=10574）和测试集（1/3，n=5288）。在训练集中，START 的受试者工作特征曲线下面积为 0.800（95%置信区间：0.792-0.809），在测试集中为 0.815（95%置信区间：0.804-0.822）。结论：通过使用有限数量的非分类预测因子，START 是第一个在大型溶栓治疗的 Safe Implementation of Thrombolysis in Stroke-International Stroke Thrombolysis Register 队列中开发和验证的列线图，它能够可靠地计算静脉溶栓治疗的卒中患者的不良结局概率。
